Hoya Insurance Agency

626-793-3800

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Limousine - Quick Quote


Please fill in this form as completely as possible.  Any fields left blank may cause a delay in the quoting process.  If you have any questions, do not hesitate to contact us directly.  This form may also be requested via fax or email.  Driver and Vehicle lists may be faxed separately.  Additional Drivers and Vehicles can be added over the phone or by separate fax or email.  Thank you for choosing Hoya! 

Company Information
Company Name
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First Name
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Last Name
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Primary Phone Number
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Alternate Phone Number
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Fax Number
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E-Mail Address
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Street
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City
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State
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ZIP / Postal Code
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Garaging Address (if different)
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FMCSA #
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Effective Date
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Years In Business
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Owner Name (First & Last)
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Type of Business
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Federal ID Number
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Destinations
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Carrier Type
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Radius of Operation
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Medical Transport?
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Describe Medical Transport:
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Is Alcohol Provided?
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Is Taxi Service Provided?
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What Is The Minimum Client Age?
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Do You Have Any Losses In The Last 3 Years?
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Current Insurance Carrier
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Policy Number
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Annual Premium
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Previous Year Insurance Carrier Name
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Previous Year Policy Number
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Previous Year Annual Premium
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2nd Previous Year Insurance Carrier Name
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2nd Previous Year Policy Number
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2nd Previous Year Annual Premium
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Vehicle #1 Model Year
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Vehicle #1 Make/Model
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Vehicle #1 VIN #
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Vehicle #1 License Plate #
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Vehicle #1 Annual Mileage
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Vehicle #1 Value When New
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Vehicle #1 Stretch (in inches)
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Vehicle #1 Customizations
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Vehicle #2 Model Year
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Vehicle #2 Make/Model
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Vehicle #2 VIN #
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Vehicle #2 License Plate #
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Vehicle #2 Annual Mileage
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Vehicle #2 Value When New
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Vehicle #2 Stretch (in inches)
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Vehicle #2 Customizations
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Vehicle #3 Model Year
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Vehicle #3 Make/Model
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Vehicle #3 VIN #
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Vehicle #3 License Plate #
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Vehicle #3 Annual Mileage
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Vehicle #3 Value When New
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Vehicle #3 Stretch (in inches)
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Vehicle #3 Customizations
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Comprehensive Deductible
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Driver #1 First Name
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Driver #1 Last Name
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Driver #1 Date of Birth
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Driver #1 License Number
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Driver #1 License State
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Driver #1 Commercial License Years of Experience
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Driver #2 First Name
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Driver #2 Last Name
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Driver #2 Date of Birth
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Driver #2 License Number
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Driver #2 License State
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Driver #2 Commercial License Years of Experience
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Driver #2 Years Experience with Current Vehicle
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Driver #3 First Name
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Driver #3 Last Name
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Driver #3 Date of Birth
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/ /
Driver #3 License number
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Driver #3 License State
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Driver #3 Commercial License Years of Experience
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Driver #3 Years Experience with Current Vehicle
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Do You Have Additional Drivers or Vehicles To Add?
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Additional Comments
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Requested Liability Limit
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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Hoya Insurance Agency, Inc.
8812 E. Las Tunas Drive
San Gabriel, CA 91776
626-793-3800



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